Ohio Admin. Code 5160-10-14

Current through all regulations passed and filed through December 9, 2024

Section 5160-10-14 - DMEPOS: compression garments

(A) The default certificate of medical necessity (CMN) form is the ODM 01905, "Certificate of Medical Necessity: Compression Garments" (rev. 7/2024).

(B) Payment may be made only for compression garments generating a pressure of at least eighteen millimeters of mercury (mm Hg).

(C) For a gradient compression garment, the provider specifies at least one clinical indication such as but not limited to the conditions identified in the following list:

(1) Elephantiasis;

(2) Lymphedema;

(3) Milroy's disease;

(4) Orthostatic hypotension;

(5) Post-thrombotic syndrome;

(6) Stasis dermatitis;

(7) Stasis ulcers;

(8) Symptomatic chronic venous insufficiency (characterized by, for example, pain, swelling, ulcers, or severe varicose veins);

(9) Symptomatic venous insufficiency associated with pregnancy; or

(10) Thrombophlebitis.

(D) Payment for an anti-embolism compression garment may be limited to three months, because such garments are generally used for short-term treatment after surgery.

(E) Payment for a post-burn compression garment cannot be made if no burn injury has occurred.

(F) It is understood that because of the nature of certain applications, authorization for payment may be granted after an item has been dispensed.

Ohio Admin. Code 5160-10-14

Effective: 7/1/2024
Five Year Review (FYR) Dates: 1/30/2024 and 07/01/2029
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 12/30/1977, 01/01/1980, 03/01/1984, 10/01/1988, 01/15/2007, 07/16/2018